Individual
AHMAD MAHALLATI-SHIRAZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 9TH AVE, SEATTLE, WA 98101-2756
(202) 223-6673
Mailing address
1100 NINTH AVENUE, C7-NEPH, SEATTLE, WA 98111
(206) 223-6673
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD60221637
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043423775
—
WA
05
—
413127400
—
MD
01
—
925031-01
BLUE CROSS/BLUE SHIELD
MD
01
—
P00981400
RAILROAD MEDICARE
WA
01
—
S062-0323
BLUE CROSS/BLUE SHIELD REGIONAL
MD
Enumeration date
05/08/2007
Last updated
06/25/2013
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